带状疱疹三区终极版课件

护理临床查房

Clinicalnursingwardround

国际住院部二科三区I.M.CInpatientDept.2Ward.3人员介绍会诊医师consultingstaff查房目的

RoundGoals掌握带状疱疹的护理。熟悉带状疱疹的病因、临床表现及治疗方法。Acquirethenursing

ofVZV.Befamiliarwiththe

theriskfactors,clinical

manifestation

and

treatmentofVZV.

Part1inquiry问诊病例报告

CaseReport阳吉菊女69岁D:Hello,MrsYang,mynameisDrDu,IamadoctorofInternalMedicine.Iwillbelookingafteryou,howcanIhelpyou?P:Yesplease!D:Howoldareyou?P:69

病例报告

CaseReport现病史患者主因阵发头痛1年，加重2天。于4月10日为进一步检查收入我科。PresentHistoryD:Pleasetellmewhat’swrongwithyou?P:Ihavehadbadheadachefor2days.D:Haveyouhadthispainbefore?P:Comeinwavesforayear.

病例报告

CaseReport现病史头颅CT无出血灶。PresentHistoryD:Haveyouhadanytestsrecently?P:IhadaheadCTandnohemorrhage.病例报告

CaseReport家族史家族中无类似病史，否认家族遗传病史。FamilyHistory

D:Doyouhaveafamilyhistoryofhealthproblems?P:No病例报告

CaseReportD：你还有什么问题需要问我吗？P：现在没有。D：如果你有什么问题，你可以问护士，如果她不知道怎么办，她会找知道的人来帮助你。D:Arethereanyquestionsyouwouldliketoaskme?P:No,notrightnow.D:Ifyouhaveanyproblems,pleaseaskthenurse,ifshecan’thelpyou,shewillfindsomeonewhocan.病例报告

CaseReportP：好的，非常感谢。D：不客气，再见。P:Ok,thanksverymuch.D:You’rewelcome,seeyoulater.

经查阅病历、详细询问病史及查体后指示：患者目前头痛部位以右侧头皮皮疹处为著，无颅内高压症状及体征，建议联系皮肤科专家会诊进一步明确，密切观察病情。Reviewingthecase,detailedinquiringmedicalhistoryandexaming,itisindicatedthatthepatientheadachelocationmainlyattherightscalprash,have’tsymptomsandsignsofintracranialhypertension.

Recommendedcontactdermatologisttodiagoseandobsevepatient’scondition.病例报告

CaseReport

Part2groupconsultation会诊

Part3Groupdiscussion小组讨论诊断Diagnosis病变皮肤出现簇集成群水疱，沿一侧周围神经呈带状分布。有明显的神经痛，伴局部淋巴结肿大。中间皮肤正常。theblisteralongonesideoftheperipheralneverontheattachedskin.Hasobviousneuralgia,withlocallymphnodeenlargement.Middlenormalskin.诊断Diagnosis从水疱液中分离chu病毒或检测VZV，HSV抗原或DNA是鉴别诊断唯一可靠的方法。Findthevzv、theHSVantigenorDNAistheonlyreliablereasonforthediagnoise.典型表现Generalmanifestation前驱症状：轻度乏力、低热、纳差等全身症状，患处皮肤自觉灼热感或者神经痛，触之有明显的痛觉敏感，持续1～3天，亦可无前驱症状即发疹。Weak,low-gradefever,poor

appetite,loucalburningheatsensationorneuralgia,obvioussenseofpainlast1-3days,beforeblister,alsoblisterwithnoformanifestation.典型表现Generalmanifestation好发部位：肋间神经、颈神经、三叉神经和腰骶神经支配区域。Predilection:theskingovenedbyintercostal

nerve,cervial

nerve,trigeminal,lumbosacralnerve.典型表现Generalmanifestation出疹特点：首先出现潮红斑，很快出现粟粒至黄豆大小的丘疹，簇状分布而不融合，继之迅速变为水疱，疱壁紧张发亮，疱液澄清，外周绕以红晕，各簇水疱群间皮肤正常。Redspotfirstly,papulesoon,andthentheblisterwithcircumambientflush.典型表现Generalmanifestation神经痛，可在发病前或伴随皮损出现，老年患者常较为剧烈。病程一般2～3周，水疱干涸、结痂脱落后留有暂时性淡红斑或色素沉着。

Neuralgiabeforetheblisterorfollowingtheskininjury,especiallytheolder.Courseofthedieasealways2-3weeks,temporaryerythema.特殊表现Specialmanifestation眼带状疱疹

三叉神经眼支受累，眼睑红肿，结膜充血，可累及角膜形成溃疡性角膜炎，疼痛剧烈。herpeszosterophthalmicusEyelidsredswollen、

conjunctivalcongestionandmaybetheulcerative

keratitiswithseverepainbysufferingfromtheeyebranchoftrigeminal.特殊表现Specialmanifestation耳带状疱疹

病毒侵犯面神经及听神经所致，表现为外耳道或鼓膜疱疹。可出现面瘫、耳痛及外耳道疱疹三联症，称为Ramsay—Hunt综合征。herpeszosteroticus

此患者即为此特殊类型！特殊表现Specialmanifestation带状疱疹后遗神经痛

带状疱疹常伴有神经痛，在发疹前、发疹时以及皮损痊愈后均可发生，但多在皮损完全消退后或者1个月内消失，少数患者神经痛可持续超过1个月以上。minorityNeuralgialastsmorethan1month.

特殊表现Specialmanifestation其他不典型带状疱疹

顿挫型；不全型；大疱型、出血性、坏疽型和泛发型；播散型带状疱疹。

Others

Forme

fruste(only

neuralgia);incomplete(red

spot,papule);big

blister;bleeding,gangrenous,generalizedanddisseminated.全身治疗Systemictreatment抗病毒治疗（尽早应用伐昔洛韦）止痛药干扰素皮质醇类激素Antiviraltherapy(usevalaciclovirasearlyaspossible)PainkillerInterferonCortisolhormone局部治疗Localtreatment复方锌铜溶液或3%硼酸溶液作局部湿敷，外用3%～5%阿昔洛韦霜，1%喷昔洛韦霜，干扰素α-2b涂布剂，0.5%酞丁安搽剂等。眼部带状疱疹可用3%阿昔洛韦眼药水，0.5%碘苷液，干扰素α眼药水点眼，3～4次/d。Wetpackingwithcompoundzinccoppersolution,3%~5%Acyclovir、1%Penciclovir、α-2b

interferon、0.5%

Ftibamzone

applecations3%Acyclovin

eyedrop、0.5%lodineglycosidesliquid、αinterferon

3-4timeseverydayfortheherpeszosterophthalmicus局部治疗Localtreatment物理疗法：可用紫外线局部照射，音频电疗法和氦氖激光照射消炎止痛，缩短病。针刺疗法。Naturopathy:irrradiatewithultravioletrays,heliumandnitrogenlaster；audioferquencycurrenttherapyAcupuncturetherapy

护理诊断

Nursingdiagnosis

1.疼痛

2.舒适的改变

3.皮肤完整性受损4.焦虑

Pain

Comfort,alteredSkinintegrity,impairedAnxiety护理措施NursingIntervention

诊断1:疼痛

--与疾病引起的神经痛有关护理措施--遵医嘱给予镇痛剂--做好心理护理，充分发挥心理镇痛效应。PainrelatedtotheneuralgiaImplementation--Givetheanalgesicasthedoctor’solder--Psychologicalnursing

护理措施NursingIntervention

诊断2:舒适的改变

--与所患疾病引起疼痛及体位受限有关护理措施1.密切观察病情变化，取舒适卧位。2.尽量保持病房安静，减少不良刺激。

Comfort,altered

--related

tothepainandlimitedposition

Implementation

--Observethechangesofillnessclosely,getthecomfortablelyingposition

--Reducethepessimal

stimulation护理措施

NursingIntervention

诊断3:皮肤完整性受损

--与疾病引起的水疱破裂有关Skinintegrity,impaired--relatedtotheblistersrupture

护理措施NursingIntervention

Implementation

--Antiphlogosis、arefactionmainly

--No

scratching,improvepatienttraining,topreventthespreadoflesions.

护理措施1.疱疹处以消炎、干燥为主。2.不要搔抓患处，加强患者宣教，避免病灶扩散。改英文部分护理措施

NursingIntervention护理措施3.泡液未破：阿昔洛韦乳膏涂抹。4.疱疹破溃后：双氧水、生理盐水清洗，再用0.5%甲硝唑液局部湿敷。Implementation--Acyclovirapplecationswiththewholeblister--Douchewithhydrogenperoxideandnormalsaline、localwetpackingwith0.5%

metronidazolewhenrupture.护理措施NursingIntervention

诊断4:焦虑--与担心疾病预后有关。

ActivityIntolerance

--relatedtotheillness’prognosis护理措施

NursingIntervention

护理措施1.向病人及家属讲解疾病相关知识、成功治疗经验，增强战胜疾病的信心。2.宣传重视预防颈椎病，避免情绪波动，及时开导患者，缓解颈椎病的症状和预防复发。Implementation--introducetheinformationabouttheVZVandthesuccessfultreatmentexperiencestothepatiencesandtherelatives.--disseminatetopreventcervicalspondylosis,avoidmoodswing.护理措施

NursingIntervention

护理措施2.宣传重视预防颈椎病，避免情绪波动，及时开导患者，缓解颈椎病的症状和预防复发。Implementation--disseminatetopreventcervicalspondylosis,avoidmoodswing

Part4

Healtheducation健康宣教健康宣教

Healtheducation

1.按时服药，观察药物疗效及副作用。2.饮食、营养指导。3.出院后近期应注意休息，多饮水，生活规律。Takemedicine

ontime,noticethecurativeeffectandtheside-effcetmorewater